Criteria for vaccine introduction: results of a DELPHI discussion among international immunisation experts on a stepwise decision-making procedure

Background: Based on a model of a stepwise approach for decision-making on vaccine introduction, this study aimed to reveal unpublished decision aids, to assess cut-off limits or thresholds for vaccine introduction that have already been used, and to discuss the comprehensiveness and feasibility of our suggested model. Methods: Forty international immunisation experts were invited to a DELPHI discussion, 14 finally participated. Experts received a questionnaire and were asked for comments on other experts’ opinions and specification of their previously given answers in the second DELPHI round. We did not intend to develop a consensus document. Results: Though most of the DELPHI participants were not aware of decision aids other than the five that had been used for the development of our model, the international discussion revealed four additional national documents that define decision-making criteria. Except for one example with a cost-utility ratio, no defined thresholds or cut-off limits have been used in vaccine introduction decisions so far. The majority of experts believe that a stepwise approach could enhance the feasibility of decision aids. The experts agreed that the influence of each single criterion of our model should be at least “important” for decision-making. The most often mentioned possible negative consequence that could arise from a rigid stepwise procedure, was a delay of the vaccine introduction process. Conclusions: The suggested stepwise procedure provides a systematic and evidence-based standardised way to support public health immunisation policy decisions. A framework could be a common starting point

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

Background Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available. Methods A systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables. Results In total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy. Conclusions A variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches

Safety of Bevacizumab in Patients with Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials

A meta-analysis of adverse events with bevacizumab in patients with advanced cancer is reported

Costs of illness and care in Parkinson's disease:an evaluation in six countries

We investigated the costs of Parkinson's Disease (PD) in 486 patients based on a survey conducted in six countries. Economic data were collected over a 6-month period and presented from the societal perspective. The total mean costs per patient ranged from EUR 2620 to EUR 9820. Direct costs totalled about 60% to 70% and indirect costs about 30% to 40% of total costs. The proportions of costs components of PD vary notably; variations were due to differences in country-specific health system characteristics, macro economic conditions, as well as frequencies of resource use and price differences. However, inpatient care, long-term care and medication were identified as the major expenditures in the investigated countries